Propionibacterium acnes prosthetic valve endocarditis with abscess formation: a case report

BMC Infectious Diseases

Andreas F Widmer³  Larry M Baddour¹  Beat A Kaufmann²  Mario Kurz³ 

[1]Division of Infectious Diseases, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, USA

[2]Division of Cardiology, University Hospital Basel, Basel, Switzerland

[3]Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland

关键词: Rifampin;    Biofilm;    Propionibacterium acnes;    Endocarditis;   

Others  :  1134485
DOI  :  10.1186/1471-2334-14-105

 received in 2013-04-25, accepted in 2014-02-17,  发布年份 2014

【 摘 要 】

Background

Endocarditis due to Propionibacterium acnes is a rare disease. Scant data on treatment of these infections is available and is based on case reports only. If the disease is complicated by abscess formation, surgical intervention combined with an antibiotic therapy might improve clinical outcome. In some cases, cardiac surgeons are reluctant to perform surgery, since they consider the intervention as high risk. Therefore, a conservative therapy is required, with little, if any evidence to choose the optimal antibiotic. We report the first case of a successfully treated patient with P. acnes prosthetic valve endocarditis without surgery.

Case presentation

We report the case of a 29-year-old patient with a prosthetic valve endocarditis and composite graft infection with abscess formation of the left ventricular outflow tract due to P. acnes. Since cardiac surgery was considered as high risk, the patient was treated intravenously with ceftriaxone 2 g qd and rifampin 600 mg bid for 7 weeks and was switched to an oral therapy with levofloxacin 500 mg bid and rifampin 600 mg bid for an additional 6 months. Two sets of blood cultures collected six weeks after completion of treatment remained negative. The patient is considered to be cured based on absence of clinical signs and symptoms, normal laboratory parameters, negative radiology scans and negative blood cultures, determined at site visits over two years after completion of treatment.

Conclusion

To our knowledge, this is the first successfully managed patient with P. acnes prosthetic valve endocarditis with abscess formation of the left ventricular outflow tract who was treated with antibiotics alone without a surgical intervention. A six month treatment with a rifampin and levofloxacin combination was chosen, based on the excellent activity against stationary-phase and adherent bacteria.

【 授权许可】

   
2014 Kurz et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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